[unreadable] Hepatocellular carcinoma (HCC) is the 5th most common tumor and the 3rd most common cause of cancer death worldwide. In the U.S.A., it is the tumor with the largest increase in incidence over the last 10 years. The incidence and death rates are similar indicating the overall poor survival of HCC. Therefore, strategies to improve the early detection and to identify those at the highest risk are of paramount importance. For the K23 award I indicated I would do 2 studies: a case-control study of patients with HCC and cirrhosis as controls, and a prospective cirrhotic cohort study. The aims were to evaluate new tumor markers for the detection of early HCC and to identify risk factors for the development of HCC. The multicenter case-control is nearing completion, and accrual for the prospective study is well. In this proposal, there will be 2 aims: 1) is the evaluation of risk factors for the development of HCC and novel biomarkers for the early detection of HCC, and 2) the prospective evaluation of the prognosis of patients with HCC. We recently published the largest trial comparing the staging systems of HCC, and found that the Barcelona Staging systems was the best at determining prognosis of patients with HCC because it takes into account liver function, tumor burden and performance status. For the remainder of the R03, I plan to continue the prospective cohort study of patients with cirrhosis when they are seen for their routine medical care every 6 -12 months, which is based on national guidelines. I also plan to follow patients with HCC after their diagnosis at designated intervals (6weeks initially then every 2 months thereafter) to study the prognostic factors of patients with HCC and to prospectively validate the Barcelona Staging system. At the end of the K23 and R03, I will have the preliminary data for an R01 submission and more importantly, I will be on my way to being an independent investigator. [unreadable] Liver cancer is the 5th most common tumor and the 3rd most common cause of cancer death worldwide. Over the last 10 years, liver cancer has the largest increase in new tumors compared to all other cancers. Therefore, identifying the risk factors, identifying new methods for early detection and determining prognosis for this tumor is of extreme importance. [unreadable] [unreadable]